§ 58-67-78. Coverage of certain prescribed drugs for cancer treatment. - North Carolina Statutes

§ 58‑67‑78. Coverage of certain prescribed drugs for cancer treatment.

(a)        No health care planwritten by a health maintenance organization and in force, issued, renewed, oramended on or after January 1, 1994, and that provides coverage for prescribeddrugs approved by the federal Food and Drug Administration for the treatment ofcertain types of cancer shall exclude coverage of any drug on the basis thatthe drug has been prescribed for the treatment of a type of cancer for whichthe drug has not been approved by the federal Food and Drug Administration. Thedrug, however, must be approved by the federal Food and Drug Administration andmust have been proven effective and accepted for the treatment of the specifictype of cancer for which the drug has been prescribed in any one of thefollowing established reference compendia:

(1)        The NationalComprehensive Cancer Network Drugs & Biologics Compendium;

(2)        TheThomsonMicromedex DrugDex;

(3)        The Elsevier GoldStandard's Clinical Pharmacology; or

(4)        Any otherauthoritative compendia as recognized periodically by the United StatesSecretary of Health and Human Services.

(b)        Notwithstandingsubsection (a) of this section, coverage shall not be required for anyexperimental or investigational drugs or any drug that the federal Food andDrug Administration has determined to be contraindicated for treatment of thespecific type of cancer for which the drug has been prescribed.

(c)        This section shallapply only to cancer drugs and nothing in this section shall be construed,expressly or by implication, to create, impair, alter, limit, notify, enlarge,abrogate, or prohibit reimbursement for drugs used in the treatment of anyother disease or condition.  (1993, c. 506, s. 4.3; 2009‑170, s. 3.)